
        <br>
        <div>
            <form name="Claim" method="post" action="UpdateClaim.php">
                <input name="ClaimID" type="hidden" id="ClaimID" value="<?PHP print $ClaimID ?>"/>
                <table id="form" align="center" cellspacing="0"cellpadding="0">
                    <tr class="col_head">
                        <td >&nbsp;</td>
                        <td><h1>Claim Form</h1></td>
                    </tr>
                    <tr><td>&nbsp;</td><td><br>Claim Details</td></tr>
                    <?PHP print $QHTML; ?>
                    <tr>
                        <td></td><td><br><input id="btnsubmit" name="btnsubmit" type="submit" value="Submit" onClick="return(valid(document.frmclaim.txttele));" />
                        </td>
                    </tr> 
                </table>
            </form>
        </div>